Where There's a Problem, Work to Fix It
Where There's a Problem, Work to Fix It
As emergency physicians, we make difficult clinical decisions regularly. We have continuing medical education, residency training, clinical trials, and our own experience to help guide our decisions. Use of these tools leads to confidence and satisfaction with our work. However, the emergency department presents many societal problems for which we have not been prepared. I feel helpless looking into the tearful eyes of a single mother who cannot afford her medicines. Arranging a follow-up visit for the patient needing a primary care physician to manage a blood pressure of 198/112 often ends in frustration. Navigating a system with a shortage of specialists can be debilitating. These dilemmas can lead to disappointment and cynicism because of our lack of preparation and involvement in our health care system.
Last year, I had the opportunity to spend a month with an Indiana state senator and learn about the process of legislation. Let me clarify; I have no interest in politics and have no specific political affiliation. However, I wanted to see why these politicians were not more active in removing the barriers to health care my patients encounter on a daily basis. Why are physicians the only ones that care about helping patients? What I discovered was astonishing.
At the state house, I met a dermatologist, senator Gary Dillon. We spoke just prior to his last session as a retiring senator. He was reflective of his political career and his dissatisfaction with the lack of involvement by physicians and the medical community in improving health care through legislation. His comments were consistent with the 2004 JAMA article, "Is There a Doctor in the House?...Or the senate?" (CK Kraus, TA Suarez. JAMA 2004;292(17):2125-29), which illustrated the declining involvement of physicians in the political process. We have declined from the 10.7% of physician signers of the Declaration of Independence to only 1.1% of physician government officials between 1960 and 2004. Keep in mind the small role the government played in health care for our founding fathers, compared to the major role it plays in our current system. Physicians with the desire to improve care for patients are a scarce resource for policy makers and have an opportunity to make a significant impact.
Most of the problems we face in our respective departments cannot be fixed while we are working a shift. We can barely keep up with the patient load requiring immediate physician attention. However, we are uniquely positioned to use our stories and experience to improve the system. My charge is to get involved. We are emergency physicians, and we make difficult decisions with limited information all the time. Once you have made up your mind, here are a few recommendations to get started:
Now is the time to make a difference. Change is coming to our health care system. We can either complain about it or be a part of the process to make it better. As emergency physicians, we know we are the safety net for the various system failures. How we fill in the holes may vary based on our location and unique circumstances, but without exception, we should be a part of the solution.
Editor's Note: Dr. Sharp is one of five emergency physicians selected for the prestigious Robert Wood Johnson Foundation Clinical Scholars Fellowship. In July, he will join 27 other young physicians who will learn to conduct innovative research and work with communities, organizations, practitioners and policy-makers on issues important to the health of all Americans.
As emergency physicians, we make difficult clinical decisions regularly. We have continuing medical education, residency training, clinical trials, and our own experience to help guide our decisions. Use of these tools leads to confidence and satisfaction with our work. However, the emergency department presents many societal problems for which we have not been prepared. I feel helpless looking into the tearful eyes of a single mother who cannot afford her medicines. Arranging a follow-up visit for the patient needing a primary care physician to manage a blood pressure of 198/112 often ends in frustration. Navigating a system with a shortage of specialists can be debilitating. These dilemmas can lead to disappointment and cynicism because of our lack of preparation and involvement in our health care system.
Last year, I had the opportunity to spend a month with an Indiana state senator and learn about the process of legislation. Let me clarify; I have no interest in politics and have no specific political affiliation. However, I wanted to see why these politicians were not more active in removing the barriers to health care my patients encounter on a daily basis. Why are physicians the only ones that care about helping patients? What I discovered was astonishing.
At the state house, I met a dermatologist, senator Gary Dillon. We spoke just prior to his last session as a retiring senator. He was reflective of his political career and his dissatisfaction with the lack of involvement by physicians and the medical community in improving health care through legislation. His comments were consistent with the 2004 JAMA article, "Is There a Doctor in the House?...Or the senate?" (CK Kraus, TA Suarez. JAMA 2004;292(17):2125-29), which illustrated the declining involvement of physicians in the political process. We have declined from the 10.7% of physician signers of the Declaration of Independence to only 1.1% of physician government officials between 1960 and 2004. Keep in mind the small role the government played in health care for our founding fathers, compared to the major role it plays in our current system. Physicians with the desire to improve care for patients are a scarce resource for policy makers and have an opportunity to make a significant impact.
Most of the problems we face in our respective departments cannot be fixed while we are working a shift. We can barely keep up with the patient load requiring immediate physician attention. However, we are uniquely positioned to use our stories and experience to improve the system. My charge is to get involved. We are emergency physicians, and we make difficult decisions with limited information all the time. Once you have made up your mind, here are a few recommendations to get started:
First, pick the problem that bothers you the most. When you pick an issue you are passionate about, you will be able to persevere past road blocks, but most importantly, you will be the beneficiary of your own work. Or, pick a simple problem you can resolve easily. This will give immediate results and help establish an environment of change leading to the resolution of more complex problems.
Second, go to the person or entity that can fix the problem. This may be your ED director, department chair, hospital CEO, elected official, national society, etc. This is never a comfortable meeting, but it gets you involved with others who can be allies in finding solutions. Just getting to know the players in the game of health policy can be challenging. You can start with your state senator or representative; they may be surprised a physician is approaching them with a problem and potential solution. They are accustomed to getting complaints about pot holes or trash removal. You will be a refreshing change and may build a relationship that can improve future policy decisions.
Third, don't ask for money. You may need money, but how you ask for it is vital to your success. Everybody wants money. As an advocate, we want to speak for a cause. We should support our cause with numbers and evidence, but even more effective will be the stories of our patients. Don't just give policy makers a fact sheet with the number of patients killed by DUIs. Tell them the heart wrenching story about the young family you had to inform that their husband/father had been killed by a drunk driver on the way home from work. This is something people can remember. If you are not convinced, read "The Power of Stories over Statistics" by Thomas B. Newman (BMJ 2003;327:1424-27). It's not the numbers that will get us the change we are looking for; it is the passion invoked by stories that support the numbers.
Now is the time to make a difference. Change is coming to our health care system. We can either complain about it or be a part of the process to make it better. As emergency physicians, we know we are the safety net for the various system failures. How we fill in the holes may vary based on our location and unique circumstances, but without exception, we should be a part of the solution.
Editor's Note: Dr. Sharp is one of five emergency physicians selected for the prestigious Robert Wood Johnson Foundation Clinical Scholars Fellowship. In July, he will join 27 other young physicians who will learn to conduct innovative research and work with communities, organizations, practitioners and policy-makers on issues important to the health of all Americans.
